Provider Demographics
NPI:1558470179
Name:DANELICH, MARIANNA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNA
Middle Name:
Last Name:DANELICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1241
Mailing Address - Country:US
Mailing Address - Phone:763-425-3023
Mailing Address - Fax:
Practice Address - Street 1:40 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1241
Practice Address - Country:US
Practice Address - Phone:763-425-3023
Practice Address - Fax:763-425-8450
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice